From the Department of Women's Health, Dell School of Medicine, University of Texas at Austin, Austin, TX.
Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
Urogynecology (Phila). 2024 Mar 1;30(3):381-387. doi: 10.1097/SPV.0000000000001477.
The associated effect of duration of the second stage of labor (SSL) on pelvic floor symptoms development is not well studied.
This study aimed to examine the association between duration of SSL and pelvic floor symptoms at 6 months postpartum among primiparous women.
A planned secondary analysis of a multicenter randomized trial evaluating the impact of immediate versus delayed pushing on vaginal delivery rates, maternal morbidity, and neonatal outcomes was conducted between 2014 and 2018. For pelvic floor arm participants, demographic, pelvic examination, and validated questionnaire data were collected postpartum. Primary outcome was change in Pelvic Floor Distress Inventory 20 (PFDI-20) score from immediate to 6 months postpartum. Secondary outcomes included changes in the Pelvic Floor Impact Questionnaire, Fecal Incontinence Severity Index, Modified Manchester Health Questionnaire scores, and Pelvic Organ Prolapse Quantification measurements at 6 months postpartum. Participants were analyzed by SSL duration ≤60 minutes or >60 minutes.
Of the 2,414 trial participants, 767 (32%) completed pelvic floor assessments at 6 months. Pelvic Floor Distress Inventory 20 scores significantly improved at 6 months in the ≤60 minutes SSL group compared with >60 minutes SSL (-14.3 ± 48.0 and -3.2 ± 45.3, respectively; P = 0.04). Changes from immediate postpartum in total and subscale scores for other questionnaires at 6 months did not differ between groups. Prolapse stage did not differ between groups. Perineal body was significantly shorter in the >60 minutes SSL group (3.7 ± 0.7, 3.5 ± 0.8; P = 0.03).
Women with SSL >60 minutes experience less improvement in PFDI-20 scores at 6 months. Greater tissue and innervation trauma in those with SSL >60 minutes may explain persistently less improvement in PFDI-20 scores.
第二产程（SSL）持续时间对盆底症状发展的相关影响尚未得到充分研究。
本研究旨在检查初产妇 SSL 持续时间与产后 6 个月盆底症状之间的关系。
这是一项多中心随机试验的计划二次分析，该试验评估了即刻与延迟用力对阴道分娩率、产妇发病率和新生儿结局的影响，于 2014 年至 2018 年进行。对于盆底手臂参与者，在产后收集人口统计学、盆腔检查和经过验证的问卷数据。主要结果是从即刻到产后 6 个月 Pelvic Floor Distress Inventory 20（PFDI-20）评分的变化。次要结果包括产后 6 个月 Pelvic Floor Impact Questionnaire、粪便失禁严重程度指数、改良曼彻斯特健康问卷评分和盆腔器官脱垂定量测量的变化。参与者按 SSL 持续时间≤60 分钟或>60 分钟进行分析。
在 2414 名试验参与者中，767 名（32%）在产后 6 个月完成了盆底评估。在 SSL 持续时间≤60 分钟组中，与 SSL 持续时间>60 分钟组相比，6 个月时 PFDI-20 评分显著改善（-14.3±48.0 与-3.2±45.3；P=0.04）。6 个月时，其他问卷的即时和子量表评分从产后即刻开始的变化在两组之间没有差异。脱垂阶段在两组之间没有差异。在 SSL 持续时间>60 分钟组中，会阴体明显更短（3.7±0.7，3.5±0.8；P=0.03）。
SSL 持续时间>60 分钟的女性在产后 6 个月时 PFDI-20 评分的改善较小。SSL 持续时间>60 分钟的患者组织和神经损伤更大，可能解释了 PFDI-20 评分持续改善较少。
